New Insights into Potential Prevention and Management Options for Chemotherapy-Induced Peripheral Neuropathy

Abstract

Objective:Neurological complications such as chemotherapy-induced peripheral neuropathy (CIPN) and neuropathic pain are frequent side effects of neurotoxic chemotherapy agents. An increasing survival rate and frequent administration of adjuvant chemotherapy treatments involving neurotoxic agents makes it imperative that accurate diagnosis, prevention, and treatment of these neurological complications be implemented.Methods:A consideration was undertaken of the current options regarding protective and treatment interventions for patients undergoing chemotherapy with neurotoxic chemotherapy agent or experience with CIPN. Current knowledge on the mechanism of action has also been identified. The following databases PubMed, the Cochrane Library, Science Direct, Scopus, EMBASE, MEDLINE, CINAHL, CNKI, and Google Scholar were searched for relevant article retrieval.Results:A range of pharmaceutical, nutraceutical, and herbal medicine treatments were identified that either showed efficacy or had some evidence of efficacy. Duloxetine was the most effective pharmaceutical agent for the treatment of CIPN. Vitamin E demonstrated potential for the prevention of cisplatin-IPN. Intravenous glutathione for oxaliplatin, Vitamin B6 for both oxaliplatin and cisplatin, and omega 3 fatty acids for paclitaxel have shown protection for CIPN. Acetyl-L-carnitine may provide some relief as a treatment option. Acupuncture may be of benefit for some patients and Gosha-jinki-gan may be of benefit for protection from adverse effects of oxaliplatin induced peripheral neuropathy.Conclusions:Clinicians and researchers acknowledge that there are numerous challenges involved in understanding, preventing, and treating peripheral neuropathy caused by chemotherapeutic agents. New insights into mechanisms of action from chemotherapy agents may facilitate the development of novel preventative and treatment options, thereby enabling medical staff to better support patients by reducing this debilitating side effect.

Selected Risk Nutritional Factors for Chemotherapy-Induced Polyneuropathy

“…Our clinical results were also similar to data reported previously i.e., distal, symmetric neuropathy involving firstly the legs and secondly the arms in most cases [1,14,18,19]. Often, the symptoms of a sensory neuropathy, induced by oxaliplatine and taxol, were already obvious at the time of the second neurologic examination, after four initial courses of treatment.…”

<p>The Antiallodynic Effect of Nefopam on Vincristine-Induced Neuropathy in Mice</p>

“…1,2 Although the pathophysiology of CIPN is not clear, it probably results from loss of sensory terminals in the skin; alterations of membrane receptors; and changes in intracellular signaling, neurotransmission, excitability, and cellular metabolism. 3 A reduction in Meissner's corpuscles and loss of epidermal nerve fibers are other possible mechanisms of CIPN. 4 The development of CIPN may lead to a reduction in dose or discontinuation of chemotherapy, which can result in increased cancer morbidity and/or mortality.…”

“…4 The development of CIPN may lead to a reduction in dose or discontinuation of chemotherapy, which can result in increased cancer morbidity and/or mortality. 1,3 Because of these multiple mechanisms for the development of CIPN, so far, no agent has been reported to be successful in controlling CIPN optimally. Vincristine is one of the most commonly used chemotherapeutic agents for blood cancer and solid tumors.…”

Carboplatin and vincristine neurotoxicity in the treatment of pediatric low‐grade gliomas

“…Currently, there are no known medical therapies to prevent or treat vincristine‐associated neuropathy . An ongoing phase II clinical trial is evaluating the neuroprotective effects of vitamin B6 and vitamin B12 against vincristine‐induced peripheral neuropathy…”

“…20 Currently, there are no known medical therapies to prevent or treat vincristine-associated neuropathy. 17,21 An ongoing phase II clin-ical trial is evaluating the neuroprotective effects of vitamin B6 and vitamin B12 against vincristine-induced peripheral neuropathy. 22 There has been concern that the use of carboplatin might induce hearing impairment in a population already suffering from visual impairment associated with optic pathway glioma.…”